Dr. Paolo Marra

Purpose: To retrospectively report a large single-center experience of visceral artery aneurysms (VAAs) and pseudoaneurysms (VAPAs) treated with covered stenting (CS) as the first therapeutic option vs transcatheter embolization (TE). Methods: One hundred patients (mean age 59±14 years; 58 men) underwent 59 elective and 41 emergent endovascular procedures to treat 51 VAAs and 49 VAPAs. Seventy patients had TE and 30 received CS (27 Viabahn and 3 coronary stent grafts). Both TE and CS were performed in 10 cases. Results: Technical success was 96% (97% CS, 96% TE), and 30-day clinical success was 83% (87% CS, 81.4% TE). Four major complications occurred; 30-day mortality was 7%, mainly due to septic shock following pancreatic surgery. The midterm follow-up was 20.8 months in the total population and 32.8 months in the CS group. More than 6 months after CS all aneurysms remained excluded; stent patency was achieved in 88%. Twelve CS patients with >3 years’ follow-up had maintained stent patency. Conclusion: In endovascular treatment of visceral aneurysms, covered stenting was feasible in 30%. CS showed a slightly better efficacy than TE and good midterm patency. The Viabahn covered stent seems to be suitable for endovascular repair of tortuous visceral arteries affected by true or false aneurysms.

20 September 2019 in International Journal of Hyperthermia

Journal Article

Percutaneous ablation techniques for renal cell carcinoma: current status and future trends

Dimitrios Filippiadis

Giovanni Mauri

Paolo Marra

G. Charalampopoulos

N. Gennaro

Francesco De Cobelli

Percutaneous ablation is an increasingly applied technique for the treatment of localized renal tumors, especially for elderly or co-morbid patients, where co-morbidities increase the risk of traditional nephrectomy. Ablative techniques are technically suited for the treatment of tumors generally not exceeding 4 cm, which has been set as general consensus cutoff and is described as the upper threshold of T1a kidney tumors. This threshold cutoff is being challenged, but with still limited evidence. Percutaneous ablation techniques for the treatment of renal cell carcinoma (RCC) include radiofrequency ablation, cryoablation, laser or microwave ablation; the main advantage of all these techniques over surgery is less invasiveness, lower complication rates and better patient tolerability. Currently, international guidelines recommend percutaneous ablation either as intervention for frail patients or as a first line tool, provided that the tumor can be radically ablated. The purpose of this article is to describe the basic concepts of percutaneous ablation in the treatment of RCC. Controversies concerning techniques and products and the need for patient-centered tailored approaches during selection among the different techniques available will be discussed.

7 June 2021 in Journal of Clinical Medicine

Journal Article

Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

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Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator’s experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed.

About Me

Paolo Marra completed his radiology training at San Raffaele Hospital, Milan, with a focus on hepatobiliary and pancreatic diagnostic and interventional radiology and experimental preclinical imaging. This included advanced clinical and preclinical liver and pancreatic imaging and interventions, with independent research projects. Since October 2019, he has been employed as a general consultant radiologist at Papa Giovanni XXIII Hospital, where he is the contact person for the Ultrasound and Interventional Radiology sections. He teaches at the School of Medicine and Surgery, University of Milano-Bicocca, delivering lectures on several topics in diagnostic imaging and interventional radiology. Besides general responsibilities in multimodality imaging, including thoraco-abdominal CT and MR, he specializes in interventional radiology in adults and pediatric patients. His main activities are the diagnosis and interventional management of complications of liver transplantation. He is experienced in thoraco-abdominal pathologies, including peri-surgical assessment, trauma, oncology, vascular and chronic diseases. He regularly runs multidisciplinary meetings for lung cancer, liver and biliary tract cancers, adult and pediatric hepatology and liver transplantation. His professional goals are to improve the quality of work, optimizing organization and defining operational standards. He invests in professional development, research and teaching colleagues in training.

Dr. Paolo Marra

Dr. Paolo Marra

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